The risk of rebleeding after external lumbar drainage in patients with untreated ruptured cerebral aneurysms

Ruijs, Aleid; Dirven, Clemens M.F.; Algra, Ale; Beijer, I.; Rinkel, Gabriël J. E.

doi:10.1007/s00701-005-0584-5

Cited by 33 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This observation confirms previous reports in the literature already suggesting the association between external CSF drainage and a rebleeding. [19][20][21] Although the majority of rebleedings occurred almost immediately after initiation of CSF drainage, a causal relation is still difficult to prove. In this respect is would be of interest to know whether the amount of CSF drainage also plays a role.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Donkelaar

Bakker

Veeger

et al. 2015

Stroke

115

View full text Add to dashboard Cite

for example, acute hydrocephalus requiring external cerebrospinal fluid (CSF) drainage, can also interfere with early treatment. Traditionally, the critical time frame for ruptured Background and Purpose-Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We therefore aimed to determine predictors for an early rebleeding after aSAH in relation with time after ictus. Methods-This observational prospective cohort study included all consecutive patients admitted with aSAH between January 1998 and December 2014 (n=1337) at our University Neurovascular Center. Clinical predictors for rebleeding ≤24 hours were identified using multivariable Cox regression analyses. Kaplan-Meier analyses were applied to evaluate the time of rebleeding ≤72 hours after aSAH. Results-A modified Fisher grade of 3 to 4 was a predictor for an in-hospital rebleeding ≤24 hours after ictus (adjusted hazard ratio, 4.4; 95% confidence interval, 2.1-10.6; P<0.001). The numbers needed to treat to prevent 1 rebleeding ≤24 hours was calculated 15 (95% confidence interval, 10-25). Also, the initiation of external cerebrospinal fluiddrainage (adjusted hazard ratio, 1.9; 95% confidence interval, 1.4-2.5; P<0.001) was independently associated with a rebleeding ≤24 hours. Cumulative in-hospital rebleeding rates were 5.8% ≤24 hours, and 1.2% in the time frame 24-72 hours after ictus. Conclusions-In our opinion, timing of treatment of aSAH patients, especially those with an modified Fisher grade of 3 or 4 in a good clinical condition, should be reconsidered. These aSAH patients might be regarded a medical emergency, requiring aneurysm repair as soon as possible. In this respect, our findings should provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding. (Stroke. 2015;46:2100-2106.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Donkelaar

Bakker

Veeger

et al. 2015

Stroke

115

View full text Add to dashboard Cite

show abstract

“…3 Only few studies have addressed the effect of LP on the risk of rebleeding, all of them not showing an increased risk. 3,[7][8][9] The explanation for a difference with the putative risk of ventricular drainage was that CSF pressure decreases more gradually with LP.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were matched for use of antifibrinolytics, because this protects the patient against rebleeding. 19 However, for two patients in the EVD control groups, matching for clinical condition at admission could not be achieved, whereas the World Federation of Neurological Surgeons is a possible risk factor for rebleeding in some studies, 8 although not in others. 13,14,17 In the EVD control groups, the age limits were exceeded in nine patients with a mean age difference of 18 years.…”

Section: Matching Proceduresmentioning

confidence: 99%

“…2,7 Such an increased risk of rebleeding was not found in patients treated with one or more lumbar punctures (LP). 3,[7][8][9] These previous studies on the risk of rebleeding during CSF drainage had two major shortcomings. First, the exposure time (the duration of the drainage period during which the aneurysm was not occluded) was not taken into account, and second, no adjustment was made for the interval between the initial hemorrhage and the start of drainage.…”

mentioning

confidence: 99%

“…[2][3][4][5] There are conflicting reports about the risk of rebleeding from CSF drainage in patients with an unprotected aneurysm. [1][2][3][5][6][7][8][9][10][11] It has been suggested that external ventricular drainage (EVD) increases the risk of rebleeding. 2,7 Such an increased risk of rebleeding was not found in patients treated with one or more lumbar punctures (LP).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Risk of Rebleeding After Treatment of Acute Hydrocephalus in Patients With Aneurysmal Subarachnoid Hemorrhage

Hellingman

Bergh

Beijer

et al. 2007

Stroke

View full text Add to dashboard Cite

Background and Purpose-Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus. Methods-We included patients with hydrocephalus treated with external ventricular drainage or lumbar punctures within 4 days after the hemorrhage and before aneurysm occlusion. Each treated patient was matched with a control patient with untreated hydrocephalus and a control patient without ventricular enlargement. Patients and controls were matched for interval since subarachnoid hemorrhage, duration of exposure, use of tranexamic acid, clinical condition on admission, and age. We used Cox regression to calculate hazard ratios and we adjusted for rebleeding that had occurred before starting the cerebrospinal fluid drainage. Results-In the group treated with external ventricular drainage, rebleeding occurred in seven of 34 patients (21%) with treatment, in seven of 34 controls (21%) with untreated hydrocephalus, and in six of 34 controls (18%) without hydrocephalus. In the group treated with one or more lumbar punctures, rebleeding occurred in one of 21 patients (5%) with treatment, in three of 21 controls (14%) with untreated hydrocephalus, and in none of the 21 controls without hydrocephalus. The hazard ratios for rebleeding were 1.0 (95% CI: 0.4 to 2.7) for external ventricular drainage treatment and 0.7 (95% CI: 0.1 to 6.4) for lumbar puncture treatment. Conclusion-This

show abstract